ESRA19-0538 The combination of a low dose bupivacaine with clonidine in spinal anaesthesia for cesarean delivery

Background and aims

Spinal anesthesia for caesarean is a technique of choice; however, the hypotension often encountered in this context remains a concern. The objective of this study is to evaluate the effect of intrathecal low-dose bupivacaine in combination with Clonidine for cesarean section.

Methods

Comparative, prospective, open study included 224 consenting parturients, programmed for cesarean, randomized in two groups to receive: 5 mg bupivacaine, fentanyl 50Ɣ, associate with 50Ɣ clonidine in group 5 (n=112); and in group 10 (n=112) 10 mg bupivacaine, associate with 50Ɣ fentanyl. We evaluated the quality of the sensory block by its duration in D4, and the duration of postoperative analgesia. The quality of the motor block by the Bromage, and its duration. The hemodynamic impact by the incidence of hypotension, the response to filling, and the average dose of ephedrine consumed. The side effects were noted.

Results

The duration of the D4 sensory block was comparable in both groups (63.8±11.24 vs 60.2±18.3 mn), the duration of postoperative analgesia was in favor of group 5 (6.11±1.76 vs 3.69±105h). The Bromage was more intense in group 10 (1.08 Vs 1.66), as well as its prolonged duration (168.66 Vs 98.45). The incidence of hypotension was more frequent in group 10 (61.61% vs 32.25), the response to filling was in favor in group 5 (67.74% Vs33.33) and the average dose of ephedrine consumed was higher in group 10 (5.14±7.29 Vs 0.43±1.44). Nausea-vomiting were more frequent in group 10.

Conclusions

Low-dose bupivacaine reduces the hemodynamic impact of spinal anesthesia, while the combination of clonidine improves the duration of effective anesthesia.